Do Patients Follow Your Advice?

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Recently, there was a discussion about patient retention on one of the chiropractic e-lists. The dialogue started when a list member asked for ideas on how to retain patients who discharge themselves when they are asymptomatic.

The answers varied with the people; however, when you remove the personalities from the rhetoric, each statement had a similar theme that was as evident as Spam on a saltine. Most of the list respondents agreed that the doctor should have a plan in mind and work that plan to the best of his ability.

Who’s in Charge of the Asylum?

Some of the answers made me uncomfortable, such as the ones that stated they (the doctor) allowed their patients to determine their own treatment schedule. If you really want to determine the direction of your practice, that answer should be unacceptable.

Of course, I don’t recommend you act like a Neanderthal by verbally clubbing your patients into submission, then forcing them to follow your recommended treatment schedule. What you might want to consider is to get them involved with their treatment protocol in a way that will lead them to agree with its validity. The only way I know to accomplish this is to communicate the reasoning behind your recommended treatment program.

In the above context, the word “communicate” means to transmit and develop an understanding of what you are trying to accomplish with the cooperation of that patient. This sometimes requires the doctor to modify the manner in which the information is presented.

Offering a Mind Picture

For example, when you talk to your patients are you throwing words at them, or are you producing images in their minds? No offense to your patients, but I have had a few patients who are so dense that light bends around them. It sometimes takes an extra effort on your part to communicate your message.

When you tell them they should have a “checkup,” does that create an understanding and an image to the patient clarifying what you’re trying to accomplish? Or, do you then have to go into a long explanation to further explain that statement?

If the word “checkup” fails to create any image in my mind, then that word probably will draw a blank in the mind of my patient.

Instead of saying, “I want to perform a spinal checkup on you,” try changing the wording to: “Let’s look at the damaged area we worked on last time and see if it’s moving and functioning better.”

Words as Tools

Properly applied, words will set the tone of a conversation and will determine the outcome of that conversation. For example, which creates a stronger picture:

The word “panhandler” or an “unaffiliated applicant for private sector funding”?

How about the difference between being “dishonest” and “ethically disoriented”?

Does being called “ignorant” bring out your neck veins more than being called a “knowledge-based nonpossessor”?

I’m not suggesting you use such language, but you can use the same concept when talking to your patients. Do you tell your patient you are “recalling” them or inviting them in for the “necessary periodic re-examination?” The other side of the communication coin is to listen.

Why Listening is Important

The effect of words also extends to what your patient is saying to you. If you listen carefully to the shading of their words, it will reveal their thoughts.

For example, when a patient comes into your office after a six-month absence and says, “Hey Doc, I just need an adjustment,” they are indicating they feel they are in charge of their chiropractic treatment. You’re another tool in their arsenal, to be used and put back in the box. Sort of a “Doc-in the-Box.” Letting your patient wag your practice that way should be unacceptable.

Rather than get in an uncomfortable hassle with the above patient, why not perform whatever services you feel are professionally correct, then do the necessary adjustment. By doing this, you illustrate a couple of key points:

• You don’t take the administration of their care lightly.

• You are showing them you respect their body; therefore, they can trust you and your expertise.

In return, you can:

• Make certain you transmit your findings to the patient.

• Charge for the adjustment, not the checkup.

Drawing Up Your Road Map

Performing your services your way or their way is a matter of leadership between you and your patients. In order to provide your services your way, you must have a plan and goals. If you want to be the leader of your practice, then you must define its goals.

I once heard goals defined as “dreams with deadlines.”Your vision or mission is that dream. Speaking of goals, you’ll have to establish yours before exploring the issues regarding patient retention. Otherwise, you’ll not know in which direction to proceed.

Timing is Key

The best time to start preparing a patient for their lifetime of wellness care is right at the time when they tell you how much better they feel and how much they admire you as their guru of wellness. In other words, when you have rapport with that patient.

Helping your patient to understand that their body is not a static mountain range but a constantly evolving organism will assist them to look further down the well-care road.

Try to communicate to them the idea that living involves physical changes. One of the methods of coping with those changes is a periodic evaluation. Of course the exercise and nutritional components are also integral to that patient’s well-being.

A neat way to establish better understanding with your patient is to connect the explanation of their health care needs with whatever they are familiar with, such as their car or home maintenance: “If you change the oil in your car before the motor seizes, why don’t you maintain the operational integrity of your body through periodic maintenance?”

Getting a Commitment

Why do we want to get our stabilized patients on a scheduled appointment as opposed to “Well, just drop in any time you feel the need?” Because it is the beginning of a commitment. If the treatment schedule is left to your patient, then that appointment drops very low on their priority list. You lose control and turn into an unused tool sitting in the box waiting for your patient to determine the status of their own health. Why should we be content to let the wheel fall off when we could easily prevent that catastrophe by periodically tightening the lugs?

A week or so before their appointment, contact the patient and either confirm or have them call you to confirm. Again, the idea behind this is to get the patient involved in the appointment process, which strengthens their commitment.

Don’t Forget Your Staff

They have an important role in implementing your retention goals. Time should be set aside at each of your weekly meetings for training your staff to be aware of how to communicate with your patients. Your goals are to educate not befuddle, encourage not provoke, and involve not preclude your patients in regard to their lifelong health process.

Yes, it’s sometimes frustrating to try to communicate your ideas on health care to those who believe they will never put off until tomorrow what they can forget about forever. However, the hallowed words of my neighbor, Dooley, still ring true. “Ya gotta try!”

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As the editor of IntegrativePractitioner.com, Lindsay combines her background in digital journalism with her experience in planning the content Integrative Healthcare Symposium conferences. She is an avid traveler and loves to explore new cultures and languages. As a researcher and writer, she embraces the opportunity to explore topics and conversations that are both challenging and exciting, which brought her to the world of integrative medicine. Working together with colleagues and peers across the integrative healthcare community, she is eager to help stimulate important conversations and grow the movement.